Skip to main content
SpringerLink
Log in

Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis (uD) and can be performed for mild complicated diverticulitis (mcD). In several cases, outpatient treatment (OT) can be undertaken. This study assessed the 1-month failure rate of OT for uD/mcD compared to inpatient treatment (IT), and identified predictive factors for treatment failure.

Methods

All consecutive patients (2006–2012) diagnosed with uD/mcD by CT scan were retrospectively analyzed. Acute uD was defined as absence of the following: abscess, fistula, extraluminal contrast, pneumoperitoneum, and need for immediate percutaneous drainage/surgery. Acute mcD was defined as complicated diverticulitis with abscess <4 cm or pneumoperitoneum <2 cm. All patients received antibiotherapy. Treatment failure was defined as (re)hospitalization the first month after treatment onset or need of drainage/surgery during hospitalization. All patients were contacted using a standardized questionnaire.

Results

Out of 540 uD/mcD, IT was offered to 369 patients (68%) and OT to 171 patients (32%). The IT group had higher median age, more women, higher median Charlson Index, more severe median Ambrosetti score, longer median time in the emergency room, and higher median CRP. Response rates to the questionnaire were 56% (IT) vs. 62% (OT), p = 0.18. Failure rates were 32% in IT vs. 10% in OT group, p < 0.01. Among the uD/mcD patients, admission/CT time between midnight and 6 AM, Ambrosetti score of 4, and free air around the colon were risk factors for failure.

Conclusions

Outpatient treatment for uncomplicated/mild complicated diverticulitis is feasible and safe. Prognostic factors of failure necessitating closer follow-up were admission/CT time, Ambrosetti score of 4, and free air around the colon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sheth AA, Longo W, Floch MH (2008) Diverticular disease and diverticulitis. Am J Gastroenterol 103:1550–1556

    Article  PubMed  Google Scholar 

  2. Etzioni DA, Mack TM, Beart RW et al (2009) Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg 249:210–217

    Article  PubMed  Google Scholar 

  3. Jacobs DO (2007) Clinical practice. Diverticulitis. N Engl J Med 57:2057–2066

    Article  Google Scholar 

  4. Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363:631–639

    Article  PubMed  Google Scholar 

  5. Chabok A, Påhlman L, Hjern F et al (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99:532–539

    Article  CAS  PubMed  Google Scholar 

  6. Jones OM, Stevenson ARL, Clark D et al (2008) Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients. Ann Surg 248:1092–1097

    Article  PubMed  Google Scholar 

  7. Vennix S, Morton DG, Hahnloser D et al (2014) Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Color Dis 16:866–878

    Article  CAS  Google Scholar 

  8. Biondo S, Lopez Borao J, Millan M et al (2012) Current status of the treatment of acute colonic diverticulitis: a systematic review. Color Dis 14:e1–11

    Article  CAS  Google Scholar 

  9. Etzioni DA, Chiu VY, Cannom RR et al (2010) Outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum 53:861–865

    Article  PubMed  Google Scholar 

  10. Biondo S, Golda T, Kreisler E et al (2014) Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial). Ann Surg 259:38–44

    Article  PubMed  Google Scholar 

  11. Abbas MA, Cannom RR, Chiu VY et al (2013) Triage of patients with acute diverticulitis: are some inpatients candidates for outpatient treatment? Color Dis 15:451–457

    Article  CAS  Google Scholar 

  12. Moya P, Arroyo A, Pérez-Legaz J et al (2012) Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis. Tech Coloproctol 16:301–307

    Article  CAS  PubMed  Google Scholar 

  13. Lorente L, Cots F, Alonso S et al (2013) Outpatient treatment of uncomplicated acute diverticulitis: impact on healthcare costs. Cir Esp 91:504–509

    Article  PubMed  Google Scholar 

  14. Sallinen VJ, Mentula PJ, Leppäniemi AK (2014) Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients. Dis Colon Rectum 57:875–881

    Article  PubMed  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  16. Ambrosetti P, Jenny A, Becker C et al (2000) Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 43:1363–1367

    Article  CAS  PubMed  Google Scholar 

  17. Jackson JD, Hammond T (2014) Systematic review: outpatient management of acute uncomplicated diverticulitis. Int J Color Dis 29:775–781

    Article  CAS  Google Scholar 

  18. Unlü C, de Korte N, Daniels L et al (2010) A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg 10:23

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rueda JC, Jimenez A, Caro A et al (2012) Home treatment of uncomplicated acute diverticulitis. Int Surg 97:203–209

    Article  PubMed  PubMed Central  Google Scholar 

  20. Andeweg CS, Mulder IM, Felt-Bersma RJF et al (2013) Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 30:278–292

    Article  CAS  PubMed  Google Scholar 

  21. Rafferty J, Shellito P, Hyman NH et al (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944

    Article  PubMed  Google Scholar 

  22. Wong WD, Wexner SD, Lowry A et al (2000) Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 43:290–297

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Gaëtan-Romain Joliat, Jonathan Emery, Nicolas Demartines, Martin Hübner & Dieter Hahnloser

  2. Emergency Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Bertrand Yersin

Authors
  1. Gaëtan-Romain Joliat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan Emery
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas Demartines
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Hübner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bertrand Yersin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dieter Hahnloser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicolas Demartines.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joliat, GR., Emery, J., Demartines, N. et al. Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone. Int J Colorectal Dis 32, 1313–1319 (2017). https://doi.org/10.1007/s00384-017-2847-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2847-z

Keywords

Search

Navigation